Cervical Radiculopathy
Cervical radiculopathy is caused by cervical nerve root
compression. The patient will have pain and/or progressive neurological deficit
that results from conditions such as disc herniation that irritates a nerve in
the cervical spine. Cervical radiculopathy is an irritation of the cervical
nerve root. Cervical spine and shoulder problems overlap. The condition is of
cervical spine etiology if the patient’s symptoms are relieved by shoulder
abduction, by placing the hand over the head. The relief of the symptoms occurs
due to decreased tension on the nerve roots. In cervical disc problems, be
aware of false positive MRIs especially if the patient is above the age of 40
years old. Nerve conduction studies are not useful; they have a high false
negative rate. EMG and nerve studies may differentiate radiculopathy from
peripheral nerve entrapment. Cervical disc problems usually affect the lower
numbered nerve root.
When you see the middle finger numbness, then this is C7.
When compression of the C7 nerve root, there will be middle finger numbness,
triceps weakness, and the triceps reflex will be affected. The cervical nerve
roots are horizontal in orientation. It does not matter if cervical disc
herniation is central or foraminal, it will compress the same nerve root. C7
nerve root runs above the pedicle of the C7 vertebra. C5-C6 is the most
commonly affected disc and that will compress the C6 nerve root. The patient
will come to the doctor with unilateral arm pain that is relieved by arm
elevation. The numbness and paresthesia will occur in specific dermatomes. The
patient may also have upper trapezius pain or interscapular pain. The patient
may complain of occipital headache. When you examine the patient, do
provocative tests such as the spurling’s test and the shoulder abduction test.
The Spurling’s test is done by extending and rotating the neck towards the
involved side. It reproduces the symptoms by narrowing the neuroforamen. The
Spurling’s test differentiates cervical radiculopathy from peripheral nerve
entrapment. Lifting the arm above the head relieves the symptoms if the
cervical nerve roots are irritated. The Shoulder Abduction test differentiates
cervical pathology from other causes of painful shoulder etiology. Make sure
that you do not have a double crush syndrome, one in the neck and one in the
peripheral nerve. Make sure that you differentiate radiculopathy from
myelopathy. Make sure that you exclude a coexisting myelopathy. Examine the
patient for upper motor neuron signs or cervical myelopathy. Test the patient for gait instability. Test the patient for Hoffman’s sign. Test the patient for Babinski reflex. Test the patient for ankle Clonus. Check to see if the patient has hyperflexia in the upper and lower extremities (triceps/quadriceps). Even if there is a bad cervical spine disc problem on the MRI, treat it conservatively for about 3 months. Give the patient therapy and nonsteroidal anti-inflammatory medication (NSAIDS). 75% of the patients will improve with nonoperative treatment. Cervical radiculopathy is generally treated nonoperatively, in contrast to cervical myelopathy. Do surgery when there is persistent, severe pain for 6-12 weeks and/or progressive neurological deficit such as weakness or numbness. The procedure to treat cervical radiculopathy surgically is usually done anteriorly with direct removal of the lesion that causes the radiculopathy such as a herniated disc or spurs. When you place the anterior bone graft or the allograft in the disc space, you open the nueroforamen, and that will indirectly relieve the nerve. Then you will add the anterior plate. Some surgeons prefer to do a posterior approach.